CLINICAL, HISTOLOGICAL, AND VIROLOGICAL FEATURES OF HEPATITIS-C VIRUSCARRIERS WITH PERSISTENTLY NORMAL OR ABNORMAL ALANINE TRANSAMINASE LEVELS

This study was aimed to evaluate demographic, clinical, histological, and virological characteristics of 46 hepatitis C virus (HCV) carriers with persistently normal alanine transaminase (ALT) levels and to com pare the results with those obtained in a group of 52 HCV-RNA-positive patients with elevated ALT levels. Subjects with normal ALT were more often females (P < .001), were more likely to be asymptomatic (P < .0 01), and have a lower incidence of risk factors for HCV transmission ( P < .01). All patients with normal ALT had significant histological li ver damage. The mean grading and staging did not differ between patien ts with normal and those with raised ALT concentrations, Moderate to s evere hepatitis was more frequently found among subjects with normal t han with elevated ALT. HCV genotype 2a was far more common in subjects with normal (43%) than with abnormal ALT levels (6%; P < .002), genot ype 1b being more frequent in these latter (50% vs. 17%; P < .001). Pa tients with normal ALT levels had similar serum HCV-RNA titers than su bjects with raised ALT, Neither HCV genotype distribution nor viral lo ad correlated with the severity of liver damage. We conclude that sign ificant liver disease may occur irrespective of clinical symptoms, ALT levels, HCV genotypes, and viral load.